远隔缺血适应干预对动脉瘤性蛛网膜下腔出血患者凝血功能的影响

The Effect of Remote Ischemic Conditioning on Coagulation Function in Patients with Aneurysmal Subarachnoid Hemorrhage

目的探讨远隔缺血适应(remote ischemic conditioning,RIC)对动脉瘤性蛛网膜下腔出血患者凝血功能的影响。方法根据纳入及排除标准,对2017年11月-2018年5月首都医科大学宣武医院神经外科重症监护病房连续收治的24例动脉瘤性蛛网膜下腔出血患者进行RIC干预,每例患者7 d内进行5次干预,并对患者干预前后的凝血功能进行检测,包括凝血酶原时间活动度(prothrombin activity,PTA)、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、国际标准化比值(international normalized ratio,INR)、纤维蛋白原(fibrinogen,Fib)、D-二聚体及血栓弹力图(thromboelastogram,TEG)(包括R、K、Angle、MA、EPL、LY30、A、CI、G、A30等参数),血管超声监测干预前后加压肢体有无深静脉血栓形成。结果 (1)RIC干预前后,患者APTT和D-二聚体无显著性变化,PTA在干预后下降(t=3.171,P=0.004);PT(t=-2.581,P=0.017)、INR(t=-3.309,P=0.003)和Fib(t=-2.304,P=0.031)在干预后略有升高,但其平均值均在正常参考值范围内。(2)RIC干预前后,患者TEG参数中仅MA略有升高(t=-2.173,P=0.040),但仍在正常参考值范围内,其他参数R、K、Angle、EPL、LY30、A、CI、G、A30均无显著性变化。(3)RIC干预前后,患者均未见加压肢体深静脉血栓发生。结论 RIC对动脉瘤性蛛网膜下腔出血患者凝血功能无明显影响,RIC不会导致患者加压肢体深静脉血栓形成。在动脉瘤性蛛网膜下腔出血应用中RIC在影响凝血功能方面的安全性得到初步证实,但还需进一步确证和有效性验证。

Objective To investigate the effect of remote ischemic conditioning(RIC)on blood coagulation function in patients with aneurysmal subarachnoid hemorrhage(aSAH).Methods A total of 24 consecutive aSAH patients in Neurosurgery ICU of Xuanwu Hospital from November 2017 to May 2018 were enrolled in this study.All patients were given RIC intervention,with 5 times RIC for each patient within 7 days.The blood coagulation function of each patient was tested before and after each RIC intervention,including prothrombin activity(PTA),prothrombin time(PT),activated partial prothrombin time(APTT),international normalized ratio(INR),fibrinogen(Fib),D-dimer and thromboelastogram(TEG,including R,K,Angle,MA,EPL,LY30,A,CI,G,A30 and etc.).Meanwhile,vascular ultrasound was used to detect deep vein thrombosis(DVT)before and after each RIC intervention.Results(1)There were no significant change in APTT and D-dimer before and after the intervention,PTA decreased(t=3.171,P=0.004)and PT(t=-2.581,P=0.017),INR(t=-3.309,P=0.003)and Fib(t=-2.304,P=0.031)increased slightly after intervention,while all the average levels were still in normal reference ranges.(2)Of all TEG paramaters,only MA increased slightly after intervention(t=-2.173,P=0.040),but still in normal reference range,the other including R,K,Angle,EPL,LY30,A,CI,G,A30 had no significant difference before and after the intervention.(3)DVT was not detected in all patients after the RIC intervention.Conclusions RIC has no obvious effect on coagulation function in aSAH patients,and RIC doesn’t lead to DVT.The results preliminary demonstrated that aSAH patients treated with RIC have good safety.